Combined Intravenous and Irrigation Tranexamic Acid During Percutaneous Nephrolithotomy
The Role of Tranexamic Acid Combined Dose Intravenous and in Irrigation Fluid in Optimizing Percutaneous Nephrolithotomy: A Prospective, Randomized, Controlled and Double-blind Study
Percutaneous nephrolithotomy is a minimally invasive surgical procedure used to remove large kidney stones. Although it is an effective treatment, bleeding during and after the procedure remains one of the main concerns and may sometimes require blood transfusion.
Tranexamic acid is a medication that helps reduce bleeding by limiting the breakdown of blood clots. It can be given through a vein and may also be used locally in irrigation fluid during surgery. This study evaluates whether using tranexamic acid by both routes during percutaneous nephrolithotomy can reduce blood loss, improve the clarity of the surgical field during endoscopy, and reduce the need for blood transfusion.
The study included adult patients with kidney stones larger than two centimeters who were suitable for percutaneous nephrolithotomy. Patients were randomly assigned to receive either tranexamic acid through a vein and in the irrigation fluid, or normal saline as a control treatment. Blood loss was assessed using hemoglobin and hematocrit levels before and after surgery, as well as hemoglobin concentration in the irrigation fluid collected at the end of the operation. The surgeon also assessed the clarity of the surgical field using a ten-point visual scale.
The hypothesis of the study is that combined intravenous and local administration of tranexamic acid in irrigation fluid during percutaneous nephrolithotomy reduces blood loss, improves surgical visibility, and lowers the need for blood transfusion compared with normal saline.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 4
Kontakter og lokationer
Studiesteder
-
-
Qalyubia Governorate
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Banhā, Qalyubia Governorate, Egypten, 13511
- Benha University Hospital
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-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Adult patients aged 18 to 70 years.
- Patients with renal stones larger than 2 centimeters.
- Patients scheduled for percutaneous nephrolithotomy.
- Normal renal function, defined as serum creatinine less than or equal to 1.5 milligrams per deciliter.
- American Society of Anesthesiologists physical status class 1 or 2.
Exclusion Criteria:
- Hypersensitivity to tranexamic acid.
- Pregnancy.
- Current anticoagulation therapy.
- Untreated urinary tract infection or urosepsis.
- Renal anatomical anomalies, including ectopic kidney, duplex collecting system, or horseshoe kidney.
- Solitary functioning kidney.
- Decompensated coagulopathy or known hematological disease.
- Acute or chronic renal disease.
- History of cerebrovascular events or thromboembolism.
- Uncontrolled arrhythmia.
- Morbid obesity.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Combined Tranexamic Acid Group
Participants in this arm received tranexamic acid 10 milligrams per kilogram intravenously in 250 milliliters normal saline 15 minutes before induction of anesthesia, in addition to the same dose of tranexamic acid added to the first 4 liters of irrigation fluid during percutaneous nephrolithotomy.
|
Tranexamic acid was administered as a combined intravenous and local intervention during percutaneous nephrolithotomy.
The intravenous dose was given before anesthesia induction, and the local dose was added to the initial irrigation fluid used during the procedure.
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|
Placebo komparator: Normal Saline Control Group
Participants in this arm received 250 milliliters normal saline intravenously 15 minutes before induction of anesthesia, in addition to normal saline placebo added to the first 4 liters of irrigation fluid during percutaneous nephrolithotomy.
|
Normal saline was used as the placebo comparator.
It was administered intravenously before anesthesia induction and added to the initial irrigation fluid during percutaneous nephrolithotomy.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Change in hemoglobin concentration after percutaneous nephrolithotomy
Tidsramme: Preoperative, immediate postoperative, and 24 hours postoperative
|
Difference in hemoglobin concentration measured before surgery and after surgery to assess perioperative blood loss.
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Preoperative, immediate postoperative, and 24 hours postoperative
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Change in hematocrit concentration after percutaneous nephrolithotomy
Tidsramme: Preoperative, immediate postoperative, and 24 hours postoperative
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Difference in hematocrit concentration measured before surgery and after surgery as an additional indicator of perioperative blood loss.
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Preoperative, immediate postoperative, and 24 hours postoperative
|
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Need for blood transfusion
Tidsramme: Intraoperatively and up to 24 hours postoperatively
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Number of participants who required blood transfusion during the intraoperative or postoperative hospital stay period.
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Intraoperatively and up to 24 hours postoperatively
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Hemoglobin concentration in irrigation fluid
Tidsramme: At the end of surgery
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Hemoglobin concentration measured in the irrigation fluid collected at the end of surgery as an estimate of intraoperative blood loss.
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At the end of surgery
|
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Endoscopic surgical field visibility score
Tidsramme: At the end of surgery
|
Surgical field visibility was assessed by the operating surgeon using a 10-point visual scale.
The score ranges from 1 to 10, where 1 indicates very poor visibility and 10 indicates perfect visibility.
Higher scores indicate better endoscopic surgical field visibility.
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At the end of surgery
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Postoperative Hematuria
Tidsramme: Up to 24 hours postoperatively
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Number of participants who developed visible blood-stained urine after percutaneous nephrolithotomy.
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Up to 24 hours postoperatively
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Need for Additional Hemostatic Intervention
Tidsramme: Up to 24 hours postoperatively
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Number of participants who required an additional intervention to control bleeding after percutaneous nephrolithotomy.
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Up to 24 hours postoperatively
|
|
Postoperative Infection
Tidsramme: Up to 24 hours postoperatively
|
Number of participants who developed postoperative infection after percutaneous nephrolithotomy.
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Up to 24 hours postoperatively
|
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Postoperative Hematuria
Tidsramme: Up to 24 hours postoperatively
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Number of participants with visible hematuria requiring continued nephrostomy tube closure or delayed nephrostomy tube removal.
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Up to 24 hours postoperatively
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Patologiske processer
- Mandlige urogenitale sygdomme
- Calculi
- Patologiske Tilstande, Anatomiske
- Nyresygdomme
- Urologiske sygdomme
- Urogenitale sygdomme hos kvinder
- Kvinders urogenitale sygdomme og graviditetskomplikationer
- Urolithiasis
- Urinvejsregning
- Intraoperative komplikationer
- Patologiske tilstande, tegn og symptomer
- Nyre Calculi
- Nephrolithiasis
- Blødning
- Blodtab, kirurgisk
- Organiske kemikalier
- Farmaceutiske præparater
- Carboxylsyrer
- Krystalloidopløsninger
- Isotoniske løsninger
- Løsninger
- Syrer, carbocykliske
- Cyclohexanecarboxylsyrer
- Tranexaminsyre
- Salinopløsning
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- MS 33-5-2025
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
IPD-delingstidsramme
IPD-delingsadgangskriterier
IPD-deling Understøttende informationstype
- STUDY_PROTOCOL
- SAP
- ICF
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